tbuckley/cabot-search huggingface dataset:
Randomized Trial of 30 Versus 20 Gy in the Adjuvant Treatment of Stage I Testicular Seminoma: A Report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328)
Authors: William G. Jones, Sophie D. Fossa, Graham M. Mead, J. Trevor Roberts, Michael Sokal, Alan Horwich, Sally P. Stenning
Journal: Journal of Clinical Oncology (2005)

Purpose To assess the possibility of reducing radiotherapy doses without compromising efficacy in the management of patients with stage I seminoma. Patients and Methods Patients were randomly assigned 20 Gy/10 fractions over 2 weeks or 30 Gy/15 fractions during 3 weeks after orchidectomy. They completed a symptom diary card during treatment and quality-of-life forms pre- and post-treatment. The trial was powered to exclude absolute differences in 2-year relapse rates of 3% to 4% (α = .05 [one sided]; 90% power). Results From 1995 to 1998, 625 patients were randomly assigned to treatment. Four weeks after starting radiotherapy, significantly more patients receiving 30 Gy reported moderate or severe lethargy (20% v 5%) and an inability to carry out their normal work (46% v 28%). However, by 12 weeks, levels in both groups were similar. With a median follow-up of 61 months, 10 and 11 relapses, respectively, have been reported in the 30- and 20-Gy groups (hazard ratio, 1.11; 90% CI, 0.54 to 2.28). The absolute difference in 2-year relapse rates is 0.7%; the lower 90% confidence limit is 2.9%. Only one patient has died from seminoma (allocated to the 20-Gy treatment group). Conclusion Treatment with 20 Gy in 10 fractions is unlikely to produce relapse rates more than 3% higher than for standard 30 Gy radiation therapy, and data on an additional 469 patients randomly assigned in a subsequent trial support and strengthen these results. Reductions in morbidity enable patients to return to work more rapidly. Prolonged follow-up is required before any inference can be made about any impact of allocated treatment on new primary cancer diagnoses.
Structural Changes of Atrial Myocardium due to Sustained Atrial Fibrillation in the Goat
Authors: Jannie Ausma, Maurits Wijffels, Fred Thoné, Luc Wouters, Maurits Allessie, Marcel Borgers
Journal: Circulation (1997)

Background After cardioversion of sustained atrial fibrillation (AF), the electrical and contractile functions of the atria are impaired, and recurrences of AF frequently occur. Whether remodeling of the structure of atrial myocardium is the basis for this problem is not known. Methods and Results Sustained AF was induced by electrical pacing in 13 goats instrumented long-term. The goats were killed after 9 to 23 weeks, and the atrial myocardium was examined by light and electron microscopy. The changes were quantified in left and right atrial free walls, appendages, trabeculae, the interatrial septum, and the bundle of Bachmann. A substantial proportion of the atrial myocytes (up to 92%) revealed marked changes in their cellular substructures, such as loss of myofibrils, accumulation of glycogen, changes in mitochondrial shape and size, fragmentation of sarcoplasmic reticulum, and dispersion of nuclear chromatin. These changes were accompanied by an increase in size of the myocytes (up to 195%). There were virtually no signs of cellular degeneration, and the interstitial space remained unaltered. The duration of sustained AF did not significantly affect the degree of myolytic cell changes. Conclusions Sustained AF in goats leads to predominantly structural changes in the atrial myocytes similar to those seen in ventricular myocytes from chronic hibernating myocardium. These structural changes may explain the depressed contractile function of atrial myocardium after cardioversion. This goat model of AF offers a new approach to study the cascade of events leading to sustained AF and its maintenance.
Late Cardiac Mortality and Morbidity in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment
Authors: Eleanor E.R. Harris, Candace Correa, Wei-Ting Hwang, Jessica Liao, Harold I. Litt, Victor A. Ferrari, Lawrence J. Solin
Journal: Journal of Clinical Oncology (2006)

Purpose Several studies have reported increased cardiac mortality related to the use of left-sided breast or chest-wall irradiation. This study was undertaken as a comprehensive examination of the long-term cardiac mortality and morbidity after breast irradiation using contemporary irradiation techniques. Methods The medical records of 961 consecutive patients presenting between 1977 and 1994 with stage I or II breast cancer treated with breast conservation treatment were reviewed. Data was recorded on baseline pretreatment patient, tumor and treatment characteristics and on subsequent cancer or cardiac related events. The median follow-up time was 12 years. Results There was no difference in overall mortality from any cardiac cause (P = .25). Death from any cardiac cause occurred in 2% of right-sided patients and 3.5% of left-sided patients. However, in the second decade after treatment, there was a higher rate of cardiac deaths in left-sided patients, with a cumulative risk of 6.4% (95% CI, 3.5% to 11.5%) for left-sided compared with 3.6% (95% CI, 1.8% to 7.2%) for right-sided patients at 20 years. There were statistically higher rates of chest pain, coronary artery disease, and myocardial infarction diagnosed in left-sided patients (all P ≤ .002). The presence of hypertension was associated with a higher risk of coronary artery disease in left-sided patients. Conclusion Irradiation to the left breast is not associated with a higher risk of cardiac death up to 20 years after treatment, but is associated with an increased rate of diagnoses of coronary artery disease and myocardial infarction compared with right breast treatment.
3. Comprehensive Medical Evaluation and Assessment of Comorbidities:<i>Standards of Medical Care in Diabetes—2018</i>
Journal: Diabetes Care (2017)

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
The Child or Adolescent with Elevated Blood Pressure
Authors: Julie R. Ingelfinger
Journal: New England Journal of Medicine (2014)

Evaluation of children and adolescents with hypertension can detect evidence of secondary hypertension (in particular, renal disease). Initial therapy is usually nonpharmacologic, but pharmacotherapy is used if other methods fail, hypertension is severe, or there are coexisting conditions such as diabetes mellitus.
Role for Bcl-6 in the generation and maintenance of memory CD8+ T cells
Authors: Hirohito Ichii, Akemi Sakamoto, Masahiko Hatano, Seiji Okada, Hirochika Toyama, Shinsuke Taki, Masafumi Arima, Yoshikazu Kuroda, Takeshi Tokuhisa
Journal: Nature Immunology (2002)
The Safety of Newborn Early Discharge
Authors: Lenna L. Liu
Journal: JAMA (1997)

<h3>Context.</h3> —While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established. <h3>Objective.</h3> —To assess the risk for rehospitalization following newborn early discharge. <h3>Design.</h3> —Population-based, case-control study. <h3>Setting.</h3> —Washington State linked birth certificate and hospital discharge abstracts covering 310578 live births from 1991 through 1994. <h3>Patients.</h3> —Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included. <h3>Main Outcome Measure.</h3> —Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (&lt;30 hours after birth) compared with later discharge (30-78 hours after birth). <h3>Results.</h3> —Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR,1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1.91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis. <h3>Conclusion.</h3> —Newborns discharged home early (&lt;30 hours after birth) are at increased risk for rehospitalization during the first month of life.
The risks of radiation exposure related to diagnostic imaging and how to minimise them
Authors: H. E. Davies, C. G. Wathen, F. V. Gleeson
Journal: BMJ (2011)

<h3>Background</h3> Cross-sectional associations suggest a mutual impact of disease activity and psychological distress in rheumatoid arthritis (RA), but a prospective association has not been established. <h3>Objective</h3> To examine concurrent and prospective associations between psychological distress and disease activity. <h3>Methods</h3> Patients with RA (N=545, disease duration ≤1 year, age 18–83 years, 69% female, 64% rheumatoid factor (RF) positive) were monitored for 5 years. The Thompson joint score and erythrocyte sedimentation rate were assessed every 6 months. Depressed mood and anxiety were measured every 12 months. Multilevel regression analysis was used. RF positivity, age and female sex were included as covariates. <h3>Results</h3> Concurrent levels of psychological distress and disease activity were positively associated (p≤0.04). Prospectively, depressed mood was associated with disease activity levels 6 months later (p≤0.04). The Thompson joint score was associated with psychological distress levels 6 months later (p≤0.03) and also with an increase in depressed mood over the subsequent 6 months (p=0.02). No other significant prospective associations were found (p≥0.07). <h3>Conclusions</h3> Psychological distress and disease activity are positively associated when measured at the same time as well as when measured 6 months apart. While some support was found for the idea that a higher level of disease activity is a risk factor for an increase in psychological distress, the results do not support the notion that psychological distress is a risk factor for future exacerbation of disease activity.
Risk Factors for Pancreatic Cellular Injury after Cardiopulmonary Bypass
Authors: Carlos Fernández-del Castillo, Wolfgang Harringer, Andrew L. Warshaw, Gus J. Vlahakes, Greg Koski, Alan M. Zaslavsky, David W. Rattner
Journal: New England Journal of Medicine (1991)

Pancreatitis is a known complication of cardiac surgery with cardiopulmonary bypass. Although ischemia is believed to be a factor, the cause of pancreatitis after cardiopulmonary bypass remains unknown.
Familial Incomplete Male Pseudohermaphroditism, Type 1
Authors: Jean D. Wilson, Mary J. Harrod, Joseph L. Goldstein, David L. Hemsell, Paul C. MacDonald
Journal: New England Journal of Medicine (1974)

A family with incomplete male pseudohermaphroditism inherited as an apparent X-linked recessive trait was investigated. The phenotype in 11 affected family members ranged from a minimal defect in virilization in two (microphallus and bifid scrotum), to a more severe abnormality in eight (perineoscrotal hypospadias) and to almost complete male pseudohermaphroditism in one (perineoscrotal hypospadias, absent vas deferens and vaginal orifice). On the basis of these variable clinical findings, together with similar evidence from a previously reported pedigree, the four syndromes of defective virilization described by Reifenstein, Lubs, Gilbert-Dreyfus and Rosewater and their co-workers appear to represent variable manifestations of the same genetic defect, designated here as familial incomplete male pseudohermaphroditism, Type 1. Studies of blood testosterone and luteinizing hormone levels in nine affected family members and of androgen and estrogen production rates in two suggest that the underlying defect involves defective androgen action rather than decreased androgen synthesis. (N Engl J Med 290:1097–1103, 1974)
Intranasal Lidocaine for Treatment of Migraine
Authors: Morris Maizels
Journal: JAMA (1996)

<h3>Objective.</h3> —To evaluate the effectiveness of intranasal lidocaine for treatment of acute migraine headache. <h3>Design.</h3> —Prospective, randomized, double-blind, placebo-controlled trial. <h3>Setting.</h3> —Community urgent care department. <h3>Patients.</h3> —A total of 81 patients (67 women and 14 men; median age, 42 years; range, 19-68 years) with a chief complaint of headache who fulfilled criteria of the International Headache Society for migraine participated. Patients were excluded if headache had lasted more than 3 days or if the frequency of severe headache was more than once per week. <h3>Intervention.</h3> —Patients were randomized in a 2:1 ratio to receive a 4% solution of intranasal lidocaine or saline placebo, respectively. <h3>Main Outcome Measures.</h3> —The primary outcome measure was at least 50% reduction of headache within 15 minutes after treatment. Secondary measures include reduction in nausea and photophobia, use of rescue medication, relapse of headache, and change in headache disability scores. <h3>Results.</h3> —Of 53 patients who received intranasal lidocaine, 29 (55%) had at least a 50% reduction of headache compared with 6 (21%) of 28 controls (<i>P</i>=.004). Nausea and photophobia were significantly reduced (<i>P</i>=.03 and<i>P</i>=.001, respectively). Rescue medication for headache relief was needed in 15 (28%) of 53 patients in the lidocaine group vs 20 (71%) of 28 controls (<i>P</i>&lt;.001). Among those with initial relief of headache, relapse of headache occurred in 10 (42%) of 24 in the lidocaine group vs 5 (83%) of 6 in the control group (<i>P</i>=.17), usually within the first hour after treatment. <h3>Conclusions.</h3> —Intranasal lidocaine provides rapid relief of headache in approximately 55% of ambulatory patients with migraine. Relapse of headache is common and occurs early after treatment.
Oral Zinc Therapy for Wilson's Disease
Authors: GEORGE J. BREWER
Journal: Annals of Internal Medicine (1983)

Wilson's disease is an inherited disorder of copper accumulation that is fatal if untreated. Because penicillamine, the established treatment, is toxic in a substantial number of patients, we studied the efficacy of zinc treatment. We induced a negative or neutral copper balance in five out of five patients with Wilson's disease who were receiving no therapy other than zinc. Zinc acetate was given every 4 hours during the day, and the patient was not allowed to eat for 1 hour before and 1 hour after each dose. Oral zinc therapy, used according to our regimen, may now be considered in the treatment of patients with penicillamine intolerance. However, it is premature to convert patients to zinc therapy if they tolerate penicillamine well. The efficacy of zinc therapy in the initial removal of the copper burden in acutely ill patients with Wilson's disease has not yet been evaluated.
Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients With Type 2 Diabetes: A Nationwide Cohort Study
Authors: Ga Eun Nam, Wonsock Kim, Kyungdo Han, Chung-woo Lee, Yeongkeun Kwon, Byoungduck Han, Seokwon Park, Joo-Hyun Park, Yang-Hyun Kim, Do-Hoon Kim, Seon Mee Kim, Youn Seon Choi, Kyung Hwan Cho, Yong Gyu Park
Journal: Diabetes Care (2020)

OBJECTIVE Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and they commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. RESEARCH DESIGN AND METHODS We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with three or more body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed. RESULTS During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.58 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively. CONCLUSIONS Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in patients with type 2 diabetes and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in patients with type 2 diabetes.
Value of Delayed-Enhancement Cardiovascular Magnetic Resonance Imaging in Predicting Myocardial Viability After Surgical Revascularization
Authors: Joseph B. Selvanayagam, Attila Kardos, Jane M. Francis, Frank Wiesmann, Steffen E. Petersen, David P. Taggart, Stefan Neubauer
Journal: Circulation (2004)

Background— Despite the accepted utility of delayed-enhancement MRI in identifying irreversible myocardial injury, no study has yet assessed its role as a viability tool exclusively in the setting of coronary artery bypass surgery (CABG), and no study has repeated delayed-enhancement MRI late after revascularization. In a clinical trial in which patients underwent CABG by either the off-pump or on-pump surgical technique, we hypothesized that (1) preoperative delayed-enhancement MRI would have high diagnostic accuracy in predicting viability and (2) the occurrence of perioperative myocardial necrosis would affect late regional wall motion recovery. Methods and Results— Fifty-two patients undergoing multivessel CABG were studied by preoperative and early (day 6) and late (6 months) postoperative cine MRI for global and regional functional assessment and delayed-enhancement MRI for assessment of irreversible myocardial injury. Preoperatively, 611 segments (21%) had abnormal regional function, whereas 421 segments (14%) showed evidence of hyperenhancement. At 6 months after revascularization, 57% (343 of 611) of dysfunctional segments improved contraction by at least 1 grade. When all preoperative dysfunctional segments were analyzed, there was a strong correlation between the transmural extent of hyperenhancement and the recovery in regional function at 6 months ( P &lt;0.001). Of a total of 96 previously dysfunctional but nonenhancing or minimally hyperenhancing myocardial segments that did not improve regional function at 6 months, 35 (36%) demonstrated new perioperative hyperenhancement in the early postoperative MRI scan. Conclusions— Delayed-enhancement MRI is a powerful predictor of myocardial viability after surgery, suggesting an important role for this technique in clinical viability assessment.
Adverse Occurrences in Intensive Care Units
Authors: Norman S. Abramson
Journal: JAMA (1980)

Analysis of 145 reports of adverse occurrences involving patients in a medical-surgical intensive care unit (ICU), during the years 1974 through 1978, disclosed 92 instances of human error and 53 cases of equipment malfunction. A peak occurrence of reported incidents was found between midnight and 1 am. Harm occurred more frequently if the patient was unattended (72%) than attended (49%) during the incident. Mortality for patients with an incident report filed during their ICU admission (41%) was higher than for all ICU patients (21%). The importance of a well-structured incident-reporting program to minimize problems of human error and device malfunction is stressed. (<i>JAMA</i>244:1582-1584, 1980)
Idiopathic Acute Eosinophilic Pneumonia
Authors: François Philit, Bénédicte Etienne-Mastroïanni, Antoine Parrot, Claude Guérin, Dominique Robert, Jean-François Cordier
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Idiopathic acute eosinophilic pneumonia (IAEP) is characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia. We conducted a multicenter retrospective study to characterize this rare clinical entity further and to improve its diagnostic criteria. A total of 13 male and 9 female patients (mean age: 29 ± 15.8 years) presented with severe hypoxemia (PaO2/fraction of inspired oxygen ratio = 156 ± 74.1) requiring mechanical ventilation in 14 cases. Bronchoalveolar lavage was performed on all patients and showed 54.4 ± 19.2% eosinophils on differential cell count, but no open-lung biopsies were done. No clinical differences were found between patients seen at less than 7 days (n = 15) or at 7 to 31 days (n = 7) from the onset of IAEP. A total of 12 patients met the clinical criteria of acute lung injury, and eight of these patients met the criteria for acute respiratory distress syndrome. All patients recovered, either spontaneously (6) or on corticosteroid treatment (16). No relapses occurred. We conclude that: (1) diagnostic criteria of IAEP are compatible with a duration of symptoms for up to 1 month, but the response to corticosteroid treatment is not diagnostic because of possible spontaneous recovery; (2) IAEP should be considered as differential diagnosis of acute lung injury or acute respiratory distress syndrome; (3) bronchoalveolar lavage eosinophilia obviates the need for lung biopsy in IAEP.